The Psychotherapist's Role in Holding Open the Possibility for the Client's Transformation

Aside from creating a holding environment where the client feels safe and comfortable with the therapist and the therapeutic process, an experiential therapist also holds open the possibility for the client's transformation.

Transformation

What Does It Mean For the Therapist to Hold Open the Possibility for the Client's Transformation?
Many clients come to therapy feeling doubtful and pessimistic about making positive changes.  There is obviously a part of them that hopes they can change, but there is often a bigger part of them that fears they won't change and they'll be exactly where they started before they began therapy.

A skilled experiential therapist creates a space first in her own mind and then intersubjectively between the client and the therapist for the possibility of positive change--and not just any change but a transformation that makes a significant difference for the client (see my article: Psychotherapy: An Intersubjective Experience Between the Client and the Psychotherapist and A Psychotherapist's Beliefs About Psychotherapy Affects How the Therapist Works With You).

The therapist can often see possibilities even when the client cannot.  This isn't a Pollyanna notion or something that is "woo-woo."  This is based on the therapist assessing the client's personal strengths and history as well the signs of resilience in the client (see my article: Discovering Your Personal Strengths in Psychotherapy, How Experiential Psychotherapy Can Help You to Develop Your Personal Strengths and A Strengths-Based Perspective in Psychotherapy).

Fictional Clinical Vignette: The Psychotherapist's Role in Holding Open the Possibility For the Client's Transformation
The following fictional vignette, which is based on many different cases with no identifying information, illustrates this particular aspect of the psychotherapist's role:

Sam
After he relapsed on alcohol after five years of sobriety, Sam began psychotherapy.

During his first session, Sam expressed the despair about achieving sobriety again.  He talked about his relapse, which occurred while he was on a recent company retreat, "I allowed my colleagues to persuade me to drink after our meeting, even though I knew it was a mistake.  I convinced myself  that I could control it and have just one beer.  Then, I was off to the races and one drink turned into five and then I drank the whole weekend.  When I got back from the company retreat, I spoke with my A.A. sponsor and he recommended that I get into therapy.  So, here I am, but I feel like a total failure and I don't think I can get back to where I was in terms of my sobriety."

Listening to his history of struggling with alcoholism from the time he was a teenager, his long family history of drinking, childhood emotional abuse, and Sam's five year history of recovery, his therapist could tell that Sam had a lot of personal strengths (see my article: Why Is It That It's Often the Healthiest Person in a Dysfunctional Family Who Seeks Help in Therapy?).

Not only did Sam begin attending Alcoholics Anonymous on his own in his mid-20s, even though his family tried to dissuade him from going, he also successfully worked the 12 Steps with his sponsor and felt he benefited from doing it.  He was also an active participant on his A.A. meetings in terms of providing service for the meetings and he welcomed newcomers who were struggling with alcoholism.

As a teenager, despite his drinking, Sam achieved above average grades and got a college scholarship, even though his family placed little value in education and tried to persuade him not to go because they thought it was a waste of time.

When his therapist asked Sam if he had emotional support from anyone else in his family or from a mentor or coach, Sam said he had no one.  But he said he was determined to move out of a dysfunctional family environment where his father and older brothers drank heavily and he knew that a college education was necessary for him to realize his independence.

After he graduated college with honors, despite heavy drinking, he went onto law school and landed a good job in a top law firm.

Right around the time that Sam began his new job, he realized that he couldn't continue to drink heavily if he wanted to succeed, and he sought help in Alcoholics Anonymous.

He explained to his therapist that it was especially challenging for him to get sober because, similar to his family, many of the attorneys at his company, including the partners, drank heavily.  In fact, drinking was part of the culture in his company, and the attorneys were expected to take out their clients for drinks.

Sam said he knew that he wouldn't stand a chance of achieving sobriety without the support of a sponsor, so he jumped at the chance to talk to an A.A. member with many years of sobriety who was among the members who stood up at the beginners meeting and offered to be an interim sponsor.

His sponsor, who was also an attorney, helped Sam to work the 12 steps and become aware of his triggers to drinking.  He also helped him to navigate the tricky situations at work where there would be heavy drinking with partners and clients.

Sam explained to his therapist that, looking back on it, he realized that his alcohol relapse began even before he picked up his first drink.  He said it began when he cut back on the number of A.A. meetings he was attending and stopped talking as frequently to his sponsor.  Then, it culminated in not using the tools that his sponsor helped him to develop and in believing that he could have just one drink to be "one of the guys" at the company retreat.

When she heard about his family history, his psychotherapist could see that much of Sam's self doubt and fear were rooted in his history with a father who constantly criticized and belittled Sam.  Even though Sam struggled against his father's emotional abuse, there was a part of him that internalized and believed what his father said about him.

During the initial stage of therapy, his therapist sensed that Sam wasn't ready to hear her assessment that he had a lot of strengths and that if she said it at that point, he would deny it and might even leave therapy.  So, instead, she asked him if he was willing to work hard in therapy to see if he could become sober again.  When he told her that he was willing, they set up a treatment plan, which included increasing his A.A. meetings and talking to his sponsor daily as well as once a week therapy.

As his therapist formed a therapeutic alliance with Sam and felt that he was comfortable with her, she began to point out and praise him for the positive steps that he was taking.  She also pointed out his positive qualities that helped him to begin making changes.

Since his therapist was an experiential therapist, she was actively engaged in the therapy and expressed her genuine delight as he got back on track with his sobriety because she knew that this corrective emotional experience was necessary, especially given the history of emotional abuse in his family (see my articles: With Experiential Psychotherapy, There Are No Blank-Slate Psychotherapists - Part 1 and Part 2).

At that point in therapy, Sam was able to take in his therapist's emotional support and her view of him as someone who had the personal strengths to achieve an emotional transformation.

After Sam had a few months of sobriety, his therapist introduced the idea of EMDR therapy to work on the underlying trauma that was a factor in his relapse (see my articles:How Does EMDR Therapy Work: EMDR and the Brain and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Over time, Sam's confidence increased and he was able to acknowledge that he had many personal strengths that he could use to cope and maintain his sobriety in addition to therapy and his sober support system.

By the time Sam completed therapy, he realized that his therapist had believed in him all along and that this was a big part of his being able to sustain his sobriety and transform his life.

Conclusion
A skilled psychotherapist is able to hold open the possibility for clients' transformation even when clients are at a low point in therapy.

Being able to assess clients' personal strengths, as well as their challenges, and keeping in mind that with help most people's inclination is to move towards health and well-being, an experienced psychotherapist can hold open a space for positive change--especially when clients cannot see it for themselves.

Even when this holding open of a space for transformation isn't articulated by the psychotherapist, I believe that it is transmitted unconsciously in the intersubjective space between clients and their therapists.

Many clients recognize in hindsight that the therapist's role of holding onto the possibility of positive change was instrumental in helping them to achieve these changes.

Getting Help in Therapy
Experiential psychotherapists tend to be more present and actively involved in therapy.  They have seen clients' transformation against all odds and recognize the signs and signals that clients have the personal strengths necessary to make positive changes (see my article: Why Experiential Therapy is More Effective Than Regular Talk Therapy).

If you're struggling with problems that you have been unable to overcome on your own, you could benefit from working with an experiential psychotherapist who can help you to achieve a transformational experience in your life.

About Me
I am a licensed NYC experiential psychotherapist who uses contemporary psychodynamic psychotherapy, EMDR, Somatic Experiencing, clinical hypnosis, and emotionally focused therapy (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome their history of trauma as well as their own self doubts to achieve transformational experiences in their lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Early Recovery: Focusing on the "People" Part of "People, Places and Things"

The decision to get sober is one of the biggest and most challenging decisions you can make in your life.  Once you've made this decision, you need to assess your life about how you're going to maintain your sobriety.  The concept of being aware of "people, places and things" in order not to relapse is an important one.  In this article, I'm focusing on the people part of "people, places and things" because it's often one of the hardest parts of recovery (see my articles: Early Recovery: You've Stopped Drinking. Now What? and The Myth of Having to "Hit Bottom" to Change).

Early Recovery: Focusing on the "People" of "People, Places and Things"

Reassessing Your Friendships in Light of Your Desire to Remain Sober

During early recovery, people usually take stock of their lives, including the people they hang out with when they drink--their drinking buddies.  When drinking buddies are only acquaintances at the local bar, as opposed to close friends, it's less of a challenge to refrain from seeing them in order to avoid the temptation to drink.

But when the people are close friends, it's a much more difficult situation and you might need to make some hard choices in order to stay sober.   

This doesn't necessarily mean that you need to give up your friends completely.  For instance, if you have close friends, who drink a lot, but who also like to engage in other activities, you could avoid meeting them at the bar and, instead, meet them at the movies.  

When you explain to your friends that you're giving up drinking, if they're good friends, it's more than likely they will encourage you to do what's best for you regardless of how they feel about drinking.

But when you have friends who might be in denial about how much they're drinking, they could perceive your sobriety as a threat because it forces them to look at their own drinking.  

As a result, they might minimize your problem in order to avoid dealing with their own drinking problem.  This doesn't mean that your friends don't care about you.  It usually means that they're afraid to look at themselves and it's easier for them to minimize your problem than to look at their own issues.

If close friends are encouraging you to join them for drinks after you've told them that you want to stop drinking, you need to make a decision about these friendships in light of your desire to stay sober.  

The same is true for friends who are only interested in going out drinking and who have no other interests.  If they're not willing to meet you for coffee or to do something else that doesn't involve alcohol, you will need to reassess these friendships because you will be putting your well-being at risk if you go along with them to bars.

Isolation Isn't the Answer:  Getting Sober Support in Self Help Meetings

You will need emotional support to maintain your sobriety, especially if you have to give up friends (see my articles: Overcoming Loneliness and Social Isolation and Changing Maladaptive Coping Strategies That Don't Work: Avoidance).

Many people who are trying to get sober isolate themselves in order to avoid alcohol.  This might work for a short time, but it's not the answer in the long run.  

Everyone needs emotional support, especially if you're taking on the challenge of staying sober.  Isolation only makes you feel lonely and it makes it that much more likely that you'll return to alcohol as your "old friend."

You can find sober support at Alcoholics Anonymous (A.A.) meetings.  Visiting several Alcoholics Anonymous meetings is a good way to find a meeting that feels right for you because every meeting is different.  

When you find a meeting that feels right for you, you can also obtain an interim sponsor, someone who volunteers him or herself in a beginners meeting to be a temporary sponsor until you find someone that you feel comfortable with, which could be your interim sponsor or it could be someone else.

Getting Help in Therapy

But what if you attend several A.A. meetings and you feel overwhelmed by these meetings? (see my article:  Early Recovery: What If 12 Step Meetings Are Too Overwhelming For You?).

Then, you would do well to consider individual psychotherapy with a psychotherapist who has experience working with people in recovery (see my article: The Benefits of Psychotherapy and How to Choose a Psychotherapist).

Even if you're attending A.A. meetings and you have a sponsor, it's a good idea to consider individual therapy to work on the underlying issues that contribute to your excessive drinking.  

A.A. meetings and sponsorship can be important components to recovery.  But if you don't eventually address in greater depth the underlying issues that trigger your drinking, you're more prone to relapse.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients who are in recovery to stay sober.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

Many people who are recovering from addiction don't understand the concept cross addiction, which is substituting one addiction for another (see my other articles about substance abuse:  Recovery: Maintaining a Balanced Life,  "Liquid Courage:" Overcoming the Temptation to Abuse Alcohol to Cope With Social Situations, The Myth About Having to "Hit Bottom" to Change, and Coping With Addiction: Boredom as a Relapse Trigger).

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

The reason it's so important to understand cross addiction is that people who have a history of addiction often switch from one addiction to another, especially when they're under stress.

So, for instance, if someone who has been sober from alcohol for a few years suddenly finds himself under a lot of stress at work, instead of picking up a drink, he might start to abuse prescription drugs or gamble compulsively or engage in some other form of addiction.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

It's easy to fool yourself into thinking that you can dabble with another addiction because it's not your primary addiction.

But when you're under a lot of stress and you haven't developed adequate skills, if you have a history of addiction, you're more likely to either relapse with your primary addiction or engage in cross addiction.

Let's take a look at a fictional vignette to see how this plays out:

Fictional Vignette: Recovery: Understanding Cross Addiction: Substituting One Addiction For Another:

Connie:
Connie was sober from alcohol for two years.  During that time, she struggled to maintain her sobriety, but with the help of her psychotherapist and her sponsor, she celebrated her second year as a sober person.

Soon after she celebrated her second anniversary of sobriety, she left Alcoholics Anonymous and told her psychotherapist that she wanted a break from therapy.

A few months later, her mother fell, broke her hip and had to go to an inpatient physical rehabilitation center.  When her mother got home, she needed Connie's help because she wasn't able to take care other daily needs.

Although Connie and her mother had a conflictual relationship, Connie agreed to move in with her mother temporarily to help her.  She knew that other siblings, who also had conflicts with their mother, wouldn't be willing to do it and her mother really needed help.

The stress of taking care of her mother and working a full time job took a toll on Connie after a few weeks (see my article: Are You Experiencing Chronic Stress and Unaware of It?).

There were times when she wanted to tell her mother to fend for herself, but she knew her mother couldn't be alone, so she tolerated her mother's emotional abuse.

Connie was often tempted to have a drink, but she knew that if she had one, she wouldn't be able to stop, so she refrained from drinking.  But she started using food to soothe her stress, and she gained 20 pounds within a few months.

Recovery: Understanding Cross Addiction - Substituting One Addiction For Another

When she went to the doctor for her annual checkup, her doctor couldn't believe that Connie had put on so much weight since the last time he saw her.

Knowing that Connie had a history of alcohol abuse, her doctor asked her if she was overeating.  When Connie told him that she was "stress eating" at her mother's home, he talked to her about cross addiction and recommended that she get back into therapy.

Connie had never heard of cross addiction.  Before she saw her doctor, she thought that as long as she didn't touch alcohol, she was doing well.  But when her doctor explained cross addiction to her, it made sense to Connie, and she knew she needed to take care of herself (see my article: Self Care For Caregivers).

The next day, Connie called a family meeting with her siblings and explained to them that they needed to pitch in.  She could no longer take on the sole responsibility of being her mother's caregiver.

At first, her siblings balked, but Connie insisted that either they help her out or she would hire a home attendant for their mother.

None of Connie's siblings wanted a home attendant in their mother's home, so they agreed to work out a schedule so they could take turns taking care of their mother.  Since there were seven of them, they each took a day, and sharing the responsibility made it less stressful.

Once her siblings were involved, Connie went back to her former psychotherapist to deal with her stress eating and unresolved issues about her mother (see my article: Returning to Therapy).

She also resumed attending Alcoholics Anonymous meetings, and she contacted her old sponsor on a daily basis.

With emotional support and reduced stress, Connie was able to get back on track so she could eat in a healthy way again and lose the weight she gained.

She also had a new appreciation for how stress could put her at risk for cross addiction.

Conclusion
The term "cross addiction" refers to substituting one addiction for another.

The fictional vignette above highlights how important it is to recognize your particular vulnerability to cross addiction and also the importance of self care, self help meetings, and getting help in therapy.

Getting Help in Therapy
Setbacks are part of recovery and part of psychotherapy (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

If you've had a setback in your recovery, it's important to get help before the problem progresses (see my article: The Benefits of Psychotherapy).

A skilled psychotherapist, who is knowledgeable about addictions, can help you to get back on track again (see my article: How to Choose a Psychotherapist).

Rather than struggling on your own, contact a licensed mental health professional who has an expertise in addictions so you can remain healthy.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to establish and maintain their recovery.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Understanding the Difference Between "I Can't" and "I Won't"

Understanding the difference between "I can't" and "I won't" is often the key to successfully making lasting changes in your life.  While "I can't" means you're not capable of doing it, "I won't" implies a choice--in other words, you're not willing to do it (see my article: Fear of Making Changes, Making Changes: Are You Creating Obstacles For Yourself Without Even Realizing It? and Making Changes: Overcoming Ambivalence).

Understanding the Difference Between "I Can't" and "I Won't"

Often, when people really mean "I won't," they say, "I can't."

For instance, when someone, who he wants to give up smoking, says, "I can't," he's saying that he thinks it will be too hard for him to do it so he chooses not to do.  Although he might not see it that way, if his psychotherapist explored the meaning of "I can't," it usually comes down to choosing not to do it (see my article: Becoming a Successful Nonsmoker).

While it's understandable that change can be scary, when you say, "I can't" it tends to foreclose any discussion about the obstacles that are getting in the way.  Whereas if you say, "I won't do it because I'm afraid that I'll fail" or "I won't do it because I'm too ashamed to admit that it's a problem," that leaves an opening for an exploration of the internal obstacles getting in the way.

The Clinical Implications of "I Can't" and "I Won't" in Psychotherapy

People often come to therapy because they want to make a change in their life.  Usually, they've tried on their own to make changes, but they run into obstacles.

Even though many people begin psychotherapy because they want to make changes, once there is a possibility for change, they often experience ambivalence because there are core issues that need to be addressed that are getting in the way.

If fear and shame are involved, and they often are, an inner conflict develops between the desire to change and the desire to remain the same and not work through the necessary obstacles to be able to change.  

The other possibility, when faced with fear and shame, is that the status quo begins to look good to the client for a while ("Maybe things aren't so bad in my life after all") until the client realizes, once again, that he really needs to change.

At that point, the client's psychotherapist can help the client, if the client is willing, to face the internal obstacles to making the change.  If the client isn't willing to explore his ambivalence, he might leave therapy prematurely (see my article: When Clients Leave Therapy Prematurely).

Let's take a look at a fictional vignette which illustrates these dynamics in therapy:

Ed

After Ed's father died, he became a compulsive gambler as a way to distract himself from his grief (see my article: Overcoming Grief Gambling).

His gambling began with March Madness and quickly progressed to other sports (see my article: Compulsive Gamblers: Beware of March Madness).

At first, when basketball season ended and he began betting on baseball games, he told himself that he would stop gambling at the end of the baseball season.  Then baseball season came and went and he was gambling on football games, and he continued to bargain with himself about stopping.

When the bookmaker refused to take any more bets from Ed because Ed owed him money, Ed got panicky.

Without the highs and lows of gambling as a distraction from his grief, he felt overwhelmed with anxiety and sadness, and this was a "wake up call" for Ed.  He knew he needed help, so he contacted a therapist who specialized in addiction.

Understanding the Difference Between "I Can't" and "I Won't"

During the initial consultation, Ed told his psychotherapist that he knew he needed to stop gambling because he was in debt for thousands of dollars and he didn't want to get any further in debt.

At that point, Ed didn't make the connection between his gambling and his fear of facing his grief over his father's death.  He only knew that he couldn't go on gambling and getting more and more in debt.

When Ed and his psychotherapist talked about when the gambling started, Ed told her that he gambled a little when he was in high school, but nothing compared to his current level of gambling.

As they traced back the origin of his compulsive gambling, Ed was able to see that it began soon after his father died.  Reluctantly, he began to put the pieces together, and he understood that he used gambling as a way to distract himself from his grief.

His therapist recommended that, in addition to coming to therapy, he also attend Gamblers Anonymous groups (G.A.), but Ed didn't think this was necessary.  He told his therapist that he would "just stop."  He believed, "I can stop whenever I want to."

Understanding the Difference Between "I Can't" and "I Won't"

His therapist decided, at that point, not to challenge Ed or insist on G.A.  She told him that they could see how he did with coming to therapy and not attending G.A.

Ed managed not to gamble for the first week, but he felt overwhelmed by anxiety and sadness, so since his bookmaker refused to take his bets until Ed paid off his debt, he told himself that he would "just place one more bet" on an Internet poker site using his credit card.

After placing the first bet, Ed felt he still had his gambling compulsion "under control," so he placed another bet and another--until he was gambling online nearly every day.

Although he felt ashamed about it, he knew that if he wasn't honest with his therapist, he would be wasting his time in therapy, so he admitted that he was now gambling online nearly everyday.

His therapist explained the brain chemistry involved with gambling and other forms of addiction and why continuing to gamble would make it that much harder to stop.

His therapist recommended that they work on coping skills so that Ed could manage his urges.  She also recommended that he identify the triggers that made him want to gamble.

Ed knew that he had a problem tolerating his anxiety and sadness related to his father's death.  Until now, he didn't realize the magnitude of his gambling problem and what it would take to overcome his problem.

He agreed to practice mindfulness meditation at least once a day, but he didn't follow through with his commitment.  Instead, he gave into his urge to gamble, telling himself each time, "This will be the last time."

When he returned to see his psychotherapist, Ed acknowledged that he didn't listen to any of the mindfulness recordings that he downloaded on his phone.

He also admitted that he was still gambling, and he was beginning to feel hopeless about overcoming his gambling addiction.   He asked his therapist, "Isn't there any easier way?" (see my articles: Beyond the Band Aid Approach in Therapy).

His therapist recommended that Ed come twice a week to therapy, attend G.A. meetings and get a sponsor in G.A.  She also explained to Ed that, when he was ready, they could work on the underlying trigger, the grief that he was avoiding.

In addition, she discussed how, if he followed her recommendations, he would probably be able to build up his tolerance for his uncomfortable feelings so they would no longer feel intolerable to him (see my article:  Expanding Your Window of Tolerance in Therapy to Overcome Emotional Problems).

At that point, Ed threw up his hands and told his therapist, "I can't.  I can't do this."

When his therapist explained the difference between "I can't" and "I won't," at first, Ed continued to maintain that he couldn't do what needed to be done to overcome his gambling addiction.

But as they continued to explore whether he was really incapable of overcoming his gambling addition or he was unwilling to give it up, Ed reluctantly admitted that he was unwilling.

At that point, his therapist and Ed had a basis to discuss his unwillingness to give up gambling and unwillingness to deal with his grief.

Over time, the more Ed talked to his therapist about his emotional struggles, the more he was able to see that he was creating obstacles for himself.  So, he followed his therapist's recommendations to practice mindfulness meditation every day, he began attending G.A. meetings, and he obtained a sponsor.

After attending a G.A. meeting, Ed told his therapist that he was surprised to discover how many people were in a similar predicament specifically related to grief gambling.  When he heard other people in G.A. speak about their guilt, shame and overwhelming sadness, he understood what they were talking about.

Gradually, Ed began to talk to his therapist about his grief.  At first, he was afraid that he would be overwhelmed, but he was surprised to discover that he actually felt better after he talked about it.

Understanding the Difference Between "I Can't" and "I Won't"

As Ed dealt with his unresolved mourning in therapy, he felt no desire to gamble.  He paid off his debts and even began to save money.

Over time, Ed was also able to see that he used the idea of "I can't" as a way to avoid dealing with his uncomfortable feelings.  Now he could see the difference between "I can't" and "I won't" and it was an important lesson in other areas of his life.

Conclusion
Even when people really want to change and they come to therapy to get help with making a change, ambivalence often sets in as the process begins (see my article: Starting Psychotherapy: It's Not Unusual to Feel Anxious or Ambivalent).

At that point, they're likely to say, "I can't" when they really mean "I won't."

Although making a change can be scary, it's a conscious choice and, by the same token, so is not making a change.

Fear and shame are usually the underlying obstacles as to why people are unwilling to take the necessary steps to change.

This is especially common for people who grew up in a family where they didn't have the emotional support they needed when faced with difficulties as a child.

On an unconscious level, they fear that they will be as overwhelmed by emotion as they were as children, but this is rarely the case.  For one thing, as an adult, there is a greater capacity to tolerate emotions (as compared to when they were children).  And, for another thing, as an adult, they have the wherewithal to ask for help.

Making a change that's challenging is often a gradual process:  One step forward and two steps back.     Along the way, there are usually setbacks before you succeed (see my article: Setbacks Are a Normal Part of Psychotherapy on the Road to Healing).

Getting  Help in Therapy
It takes courage to make a major change (see my article: Developing the Courage to Change).

There are some changes that feel so daunting that you might need help from a licensed mental health professional (see my article: The Benefits of Psychotherapy).

If you've been struggling on your own to make a change in your life, you could benefit from seeing a licensed psychotherapist who has experience helping people to overcome obstacles to change (see my article: How to Choose a Psychotherapist)

Everyone needs help at some point in his or her life, and getting help from a skilled psychotherapist could make all the difference between making a successful change or not.

The choice is yours.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to overcome the obstacles that were getting in the way of making a major change in their life.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why You Can't "Think" Yourself Into Mental Health and Wellness

Understanding and developing insight into your problems is important but, unfortunately, it's often not enough to change your problems (see my article: Healing From the Inside Out: Why Understanding Your Problems Isn't Enough).

Why You Can't Think Yourself Into Mental Health and Wellness

Many people either never go to therapy to deal with emotional problems and many others leave therapy prematurely because they believe they can "think" themselves into wellness (see my article: When Clients Leave Therapy Prematurely).

There's no denying that understanding and developing insight into your problems is important, but it's only the first step.  You use your logical mind to understand and try not to repeat the same problems, if it's in your power.

But when your problems are deeply rooted in psychological trauma, your logical mind often isn't enough.  You need help from a licensed mental health professional to help resolve on the underlying problems that go beyond the logical part of your brain.  You need a skilled therapist to help you deal with the problem on the level of the emotional brain.

Let's take a look at a fictionalized vignette that illustrates these points:

Ed
Ed grew up in a family that was nearly destroyed by his father's gambling.  He saw first hand how the family struggled whenever his father lost money at casinos.

When Ed was 10, his mother threatened to leave the father if he didn't stop gambling, so the father stopped going to the casinos.  Instead, he started drinking heavily.

Ed's mother resigned herself to being in a marriage with a man who came home and locked himself in his "man cave" in the basement and drank every night.  She was relieved that, at least, she could pay the bills.  But they continued to drift apart.

As is often the case when people give up an addiction without getting help for the underlying issues, drinking replaced the gambling and led to the father having a fatal heart attack when he was in his early 50s.

By that time, Ed was a successful manager at a top company in NYC and married to a woman that he met in college.

Looking at Ed from the outside, it appeared to most people that Ed "had it all" (see my article:

But Ed had a big secret that he was very ashamed of:   Whenever he got paid, he made big bets on sports events.

Sometimes he won, and sometimes he lost.  But no one, except the person who placed bets for him, knew about his betting, not even his wife.

Sometimes, to cover his losses, he had to withdraw money from his savings.  Then, he was desperate to recoup his losses and he would frantically place more bets.

Logically, Ed knew that he needed to stop betting, but he couldn't control his impulses.  He kept chasing his losses and if he won, he wanted to win more.

One day, his wife, Nina, happened to look at their bank statement and she was shocked to see such a low balance compared to what had been in the account only a few months ago.

Normally, she didn't look at the statements because let Ed manage their finances.  So, when she saw the balance, her first thought was that either the bank made a mistake or someone hacked into their account.

When Ed got home, she showed him the statement and asked him what he thought had happened.  At first, he hung his head and didn't respond, and Nina began to feel sick.

Reluctantly, Ed told her about his gambling problem and that he had been withdrawing the money.  Nina went into the bedroom and began to cry.

Ed tried to convince her that he had a "good feeling" about an upcoming football game and he knew he would win.  He only wanted to place one more bet to recoup his losses and then he would stop.

Ed and Nina argued for most of the night, and both of them called out sick from work the next day.

After being up all night, Ed promised Nina that he would never bet again.  He apologized profusely for keeping these secrets and betraying her.

Nina responded by telling Ed to seek help in therapy.  But Ed knew what he needed to do--he needed to stop gambling.  He told Nina that he didn't need a therapist to tell him this.  He could do it on his own.

For the next few months, whenever the person who placed his bets called him to find out it he wanted to place a bet, Ed told him that he wasn't going to bet anymore.  Each time, when he got off the phone, Ed felt dejected and tired, as if he was physically ill.

After a while, Ed began to feel bored and depressed.  He was tempted to place a bet on a basketball game, but he told himself over and over that he had promised his wife that he wouldn't do it, so he couldn't do it.  But he knew that he really wanted to do it, so he struggled with this internal conflict.

Then, one day, one of his colleagues, Jim, called Ed into his office and showed him a picture of a sexy, beautiful woman.

Ed knew Jim's family and he knew the woman in the picture wasn't Jim's wife, so he asked him about the woman.  Jim closed the office to his door and told Ed about the woman, who was with an escort service.

He told Ed in a low voice that he saw this woman from the escort service every few weeks and since he started seeing her, he felt on top of the world.  He said she told him that he was sexy and attractive and he felt like "a million bucks."

Then, Jim told Ed that he should call the service and have fun with one of the beautiful escorts.  He told him that they're very discrete and his wife would never know.

Ed laughed it off, but the image of the beautiful, sexy woman stayed in his mind.  He fantasized about how much fun it would be to be with her.  The more he thought about the happier he felt.

When Ed realized that he was feeling so good by just thinking about it, he told himself that he could try the service once and then never do it again.  He wouldn't tell anyone about it, not even Jim.  It would be his secret (see my articles: Infidelity: Married, Bored and Cheating and Overcoming Addiction: Boredom as a Relapse Trigger).

At the time, Ed didn't know about cross addiction and how a person could replace one addiction, like gambling, with another addiction, like sexual addiction.

Months later, his wife discovered an ad for an escort service in the pocket to Ed's jeans as she was doing laundry and got very upset.

When Ed got home, she threw the ad on his lap.  Ed froze and remained silent.

A week later, Ed began therapy with a psychotherapist who specialized in working with addictions, even though he wasn't convinced that he needed to be in therapy.

Over time, Ed learned about cross addiction and remembered that his father stopped gambling and began drinking heavily.

He also began doing the necessary work to understand the underlying issues that were part of his addiction, in addition to the possible genetic component, and what triggered him.

The work wasn't easy or quick but, gradually, Ed began to realize that he couldn't just "think" himself into wellness.  He couldn't just tell himself not to gambling or engage in sex with escorts because that wasn't enough to override the deeper emotional issues that had to be worked through in therapy.

As he worked through the underlying emotional trauma and became aware of his triggers, Ed's impulse to gamble or have sex with escorts began to diminish because the underlying issues were getting worked on.

At the same time, Ed knew that he could never allow himself to become complacent and, along with therapy, he also attended Gambler's Anonymous and worked the 12 Steps with a sponsor.

Conclusion
There's a common misperception that if you understand your problems, you can avoid making the same mistakes.

While this might be true for certain problems, when you're dealing with more complex issues that have involve unconscious underlying issues, just telling yourself "to stop" isn't enough.

You might have the best intentions of never engaging in this behavior again, but it's not enough.

As many people know who have tried to stop engaging in addictive or dysfunctional behavior, it's very easy to replace one dysfunctional behavior with another, as the vignette above illustrates.

Whether it's gambling, sexual addiction or any other addictive behavior, you can get the same dopamine "rush" from many different types of dysfunctional behavior and this makes it difficult to stop.

Until you work through the underlying issues and discover your triggers, you will, most likely, continue to struggle or "white knuckle it" for a while, risking your relationship, your family, your job and everything that is precious to you.

Getting Help in Therapy
It's not easy asking for help (see my article: Overcoming Your Fear of Asking For Help).

It's much easier to be in denial and to tell yourself that you can do it on your own.

Many people wait until they lose everything before they seek help, but it doesn't have to be that way (see my article:  The Myth About Having to "Hit Bottom" to Change).

Taking the first step of setting up a consultation can be your first step in your recovery.

Working with a skilled psychotherapist who has experience helping people with addictive behavior and emotional trauma can help to free you from an unhappy existence.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialties is helping clients to overcome the emotional trauma that is creating problems in their lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Myth About Having to "Hit Bottom" to Change

The myth that people who have addiction problems have to "hit bottom" before they decide to change is both extremely dangerous and completely wrong.  This is an outdated concept that is still around in some recovery circles, and it has been detrimental to many people.

Recovery: The Myth About Having to "Hit Bottom" to Change

Even though many people in recovery now realize that "hitting bottom" is detrimental, there are still some people in recovery who still believe it.

If you're struggling with addiction, whether it's drinking, drugging, compulsive gambling, sexual addiction or some other form of addiction, or you love someone who has an addiction problem, it's important that you understand why the "hitting bottom" myth is dangerous.

Let's take a look at a fictionalized scenario and see how believing in the "hitting bottom" concept can be dangerous and what to do if you or a loved one is stuck in this type of distorted thinking.

Ed
Ed began gambling in college.  Initially, his gambling involved sports, like gambling on the Super Bowl.  Over time, it grew to include other forms of gambling.

While in high school, Ed was able to hide his gambling from his parents.  But by the time he was a senior in college, he gambled away his tuition money, so he was forced to reveal his gambling problem to his parents.

Ed promised his parent that he would never gamble again, so they lent him the tuition with the agreement that he would pay them back when he graduated college and began working.

When he graduated college, Ed got a high-paying job in finance and he began to pay his parents back.  Little did his parents know that Ed never stopped gambling, and his secret gambling problem had progressed to include going to the casinos, playing high stakes poker with friends, and online gambling.

Recovery: The Myth About Having to "Hit Bottom" to Change

After a few months, despite his high salary, Ed was making excuses to his parents as to why he was unable to make his monthly payments to them.  He was also asking to borrow more money from them.

By then, Ed's parents realized that he had not been honest with them and he was still gambling, so they confronted him about it.  At first, he denied it.  Then, he admitted that it was true.  But he felt that he could "control it" if he wanted to and rejected their suggestion to get help in therapy or to attend Gamblers Anonymous.

Recovery:  The Myth About Having to "Hit Bottom" to Change

Not sure what to do, Ed's parents spoke to a close friend, Tom, who once had a gambling problem, but who overcame it by attending Gamblers Anonymous (G.A.).  Tom had been in recovery for many years, and he rejected their idea to have a family intervention to confront Ed about his gambling problem.

Instead, Tom told Ed's parents that Ed would only be willing to change after he had "hit bottom." He told them that it would be useless for them to try to persuade Ed before that, and they should let Ed find his own way to his "bottom."

Ed's parents weren't sure what to do.  They were worried that Ed's gambling would continue to get progressively worse if they didn't urge Ed to get help.  But they decided that Tom had a lot of experience in G.A. and he must know what he was talking about.  So, with much difficulty, they stood by while Ed continued to gamble, hoping that he would "hit bottom" soon before he had ruined his life.

A year later, Ed's parents were shocked and dismayed to discover that Ed was arrested for attempted fraud as part of an internal investigation in his company.  He was taken out of the company in a pair of handcuffs.

Recovery: The Myth About Having to "Hit Bottom" to Change

Fortunately, since it was his first offense, the judge mandated Ed to get into treatment, a combination of psychotherapy and Gamblers Anonymous in lieu of going to jail.

His parents attended some of his therapy sessions in order for them to understand what happened and for Ed to repair his relationship with his parents, who were hurt and angry.

During one of those sessions, Ed told his parents that, before he was arrested, he was sure that he could stop gambling at any time if he really wanted to do it.  But, after a while, he was deeply in debt to loan sharks and he was so desperate that he did what he never would have thought he would do--he tried to embezzle money from his company.

Ed took full responsibility for his actions.  But his parents realized that following Tom's advice to allow Ed to "hit bottom," rather than doing a family intervention earlier on, was ill advised.

The therapist, who had an addictions background, also advised them that "hitting bottom" was a dangerous myth.

Conclusion
The motivation to change can come in many different ways.

Sometimes, people get a wake up call that they're heading down a slippery slope and they need to make changes in order to avoid a disastrous end.

Other times, people make a few false starts before they make a commitment to change.

The idea of "hitting bottom" would certainly be seen as ridiculous with just about any other type of problem.  Imagine telling someone who had a progressive medical problem that s/he had to wait until the problem got much worse before s/he got help.

The idea of "hitting bottom" is just as ridiculous and dangerous when it comes to addiction.

Getting Help
If you have a loved one who is caught in the grip of an addiction, rather than waiting for the problem to get worse, express your concern.  If that doesn't work, try doing a family intervention in a loving and tactful way to let your loved one know that the family cares and is concerned.

If you're the one who is struggling with addiction, get help sooner rather than later, before there are serious consequences to you and your loved ones.

Living a healthy and fulfilling life is its own reward.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me. 

Adult Children of Dysfunctional Families Often Have Difficulty Completing Things

As I mentioned in earlier articles, until they get psychological help, many adult children of alcoholics (ACOAs) and dysfunctional families have difficulty in adult relationships.

Adult Children of Dysfunctional Families Often Have Difficulty Completing Things

These difficulties usually stem from growing up in a family where they lived in a chaotic household where the parents were often drunk, unpredictable, irresponsible and created chaos in the family.

Since dysfunctional family dynamics are often intergenerational, chances are good that these patterns will continue from one generation to the next until the adult child of a dysfunctional family decides to get psychological help to break this pattern.

One of the difficulties is problems completing things, which include personal project, educational pursuits, work projects and so on.

The following vignette, which is a composite of many different cases to protect confidentiality, illustrates how these dynamics play out as well as how to break this pattern:

Dan

Dan grew up in a large family where his father, Joe, was a heavy drinker and his parents often argued because of Joe's alcoholism.

Adult Children of Dysfunctional Families Often Have  Difficulty Completing Things

As far back as he could remember, his family's social activities revolved around the local bar.  As the oldest child of seven children, he was usually the one who helped his father to walk home on a Saturday evening at closing time when his father was too drunk to walk on his own.

Since many of Dan's friends in the neighborhood had the same role in their families, Dan didn't realize, until he became an adult, that there was anything unusual about this.  He thought that this was just how life was for the average family.

Over the course of Dan's childhood, his father had many jobs as a plumber's assistant.  Most of the time, his father would begin these jobs with enthusiasm.  But soon after he began, he would complain about the boss's unfairness, perceived slights, and many other gripes that he would had.

Within a few months, he began to go in late or he just didn't show up at all.  On the days when he didn't bother to go in, he would hang out with his buddies in the bar.  Soon after that, he would lose his job and begin searching for another one where he would repeat the same pattern.

As a result, the family was often in a state of emotional and financial chaos.  Dan's mother, Liz, Dan and his brothers were usually on an emotional roller coaster, hoping the good times would last when times were good and dreading that the bad times would never end when times were bad.

As Joe's drinking problem progressed, Liz got a job as a school aide to help pay the bills.  Even though her salary was low, she managed, somehow, to always have food on the table, although it might be meager.  But she was constantly fending off the landlord, threats of eviction, and bill collectors.

When Joe could no longer work because his alcoholism created health problems, as a young adult, Dan became the primary breadwinner for the family, and his younger brothers helped out by getting part time jobs.  During that time, his mother went to nursing school and eventually got a job in a hospital as a nurse.

Volunteering for double shifts, Liz earned more money than the family had ever seen.  By then, Dan was able to enroll in college where he met and fell in love with Linda.

Adult Children of Dysfunctional Families Often Have Difficulty Completing Things

Throughout his life, Dan had difficulty completing things.  Even when he was a child, he would start assembling a model car with enthusiasm, but then he would lose interest and drop the project.

Dan was enthusiastic about starting college, but he soon found himself struggling to stay organized and keep up with the work.  Since he was very bright, he sailed through high school without much effort and without completing many of his assignments, but he discovered that college required more, which frightened him.

Whenever Dan felt frustrated and wanted to quit, Linda would encourage him to stick it out.  She helped him to try to stay calm and get organized, but he continued to struggle with an urge to quit.

At that point, Dan realized that he had a problem, but he didn't understand what was happening to him.  So, he decided to go to the college counseling center, where he was able to have three sessions with a clinical social worker, who provided Dan with psychoeducation about how adult children of alcoholics are often affected by their family dynamics.  After the three sessions, his college counselor referred Dan to me for psychotherapy.

Initially, Dan had a problem making a commitment to come to his therapy sessions.  He seemed always on the verge of leaving, saying that he understood his problems and he didn't see the need to continue.

The initial stage of our work involved helping Dan to develop better coping skills, which he was never taught as a child.  As a result, Dan had low tolerance for frustration or anything that required sustained effort.

At that point in his therapy, his motivation was mostly external:  He knew that if he quit college, his chances of getting the kind of job that he wanted would be nil.  

I helped Dan to see the difference between intellectual insight, which is what he had at that point, and actually using this insight to make the changes he said he wanted to make.  As we looked at his life, he admitted that insight alone wasn't helping him to change.

Then, we began working on Dan's early childhood trauma, including the shame that he felt about himself and his family, as well as breaking self destructive patterns related to his trauma.

Even though Dan was aware of the negative impact of his family dynamics, until then, he never thought of himself as having been traumatized.  He had problems accepting this, at first, until he began to connect, on an emotional level, his experiences in his family with his current problems.

Since talk therapy only took us so far, I introduced Dan to concepts of mind-body oriented psychotherapy, including clinical hypnosis, EMDR (Eye Movement Desensitization and Reprocessing) and Somatic Experiencing.

Over time, by using EMDR, Dan began to work through his childhood trauma (see my article:  What is EMDR? and How Does EMDR Work?).  It wasn't easy work, but the coping skills that he learned early on in therapy helped him.

Gradually, Dan noticed that he began to feel better about himself and he no longer felt ashamed.  He no longer felt responsible for his father's alcoholism and his enmeshed childhood family dynamics.

As Dan became more self aware and self confident, he was able to tolerate frustration better and he no longer felt the need to quit college.  He completed his assignments on time and enjoyed learning.

As Dan saw positive results in our work, he felt encouraged to continue to do the work.  He also began attending Al-Anon for additional emotional support, and Liz attended her own Al-Anon meetings to help her avoid codependent dynamics.

Dysfunctional Family Dynamics Without Alcohol
Although this article focuses on ACOA dynamics related to alcoholism, many people, who grew up in dysfunctional families where there was no substance abuse, also experience similar dynamics.

Aside from substance abuse, intergenerational patterns of trauma, regardless of their origins, can create similar dynamics.

See my other articles on this topic:
Dynamics of Adult Children of Dysfunctional Families

Adult Children of Dysfunctional Families: Confusing Love and Pity

Adult Children of Dysfunctional Families and People Pleasing

Getting Help in Therapy
Many people who are affected by childhood trauma related to dysfunctional families, never get the psychological help that they need.  The result is that they continue to perpetuate these dynamics in their own lives as well as in their children's lives.

If these issues resonate with you, even though taking the first step might seem hard, you owe it to yourself and your spouse and family to get psychological help from a licensed mental health professional who has experience helping clients with these issues.

With help in therapy, you and your family could be living a happier life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

I have helped many clients who grew up in dysfunctional families to thrive.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Early Stage of Recovery: What to Do If 12 Step Meetings Are Too Overwhelming For You

Generally speaking, as a psychotherapist, I recommend 12 Step meetings, especially during the early stage of recovery.  But I also know that for many people, especially people who have a history of emotional trauma, going to 12 Step meetings can be too overwhelming during the initial stage of recovery.

Early Stage of Recovery: What to Do If 12 Step Meetings Are Too Overwhelming For You

12 Steps Meetings Have Saved Many Lives
The 12 Steps, which are principals for living life, provide a structured step-by-step philosophy that many people describe as having been life saving for them.

Many of these people struggled in isolation and shame with their addiction before they began attending 12 Step meetings. But when they began going to meetings, they discovered that they were not alone.  This provides many people with a sense of comfort and safety.

12 Step Meetings Have Saved Many Lives

In most 12 Step meetings, many people in early recovery can find mutual support among other people who are also struggling with addiction.  There is also an opportunity to find a sponsor who can help with working through the 12 Steps.

For Many People With Emotional Trauma, 12 Step Meetings Are Too Overwhelming
But there are many other people, who have a history of emotional trauma, who find the meetings to be too overwhelming, especially when they hear stories in the meetings that triggers their trauma.

When people feel triggered during the early stage of recovery by hearing stories that are overwhelming, they can feel like drinking or drugging (or gambling, overeating and so on, depending upon their addiction).

Many people, who get emotionally overwhelmed override their own sense that they are making themselves too emotionally vulnerable to relapse because they feel that there's something wrong with them if they can't tolerate being at the meetings.

After all, they think to themselves, many people have told them that going to 12 Step meetings is good for them.  So they continue to force themselves to go and continue to get triggered and retraumatized because they're not ready to hear other people's traumatic stories in the meeting.

Of course, there are also a multitude of success stories in the meetings about how people have achieved years of sobriety and many stories about hope and transcendence.

But, for many people with a history of emotional trauma, it only takes one difficult story to overwhelm them and then they relapse.  They're just not ready, at that point, to attend 12 Step meetings.

Getting Triggered is a Common Experience For People Who Have Been Traumatized
There is no reason to feel ashamed about this.

Getting Triggered is a Common Experience For People Who Have Been Traumatized

Getting emotionally triggered is a common experience for people who experienced trauma.

Just like a veteran who returns from war can get triggered when he or she hears the backfiring of a car which sounds similar to an war time explosive, anyone who has trauma can get triggered when they're in particular situations.

Getting Help in Therapy
If you are in the early stage of recovery and you're finding it too difficult to attend 12 Step meetings, you can get help by working with a licensed mental health professional who has expertise in working with clients in early recovery who have a history of emotional trauma.

An experienced therapist can help you to develop the necessary coping skills to deal with early recovery issues as well as relapse prevention.

Many people who are in the early stage of recovery want to rush into dealing with their trauma before they're ready.  They feel that they've wasted too much time and they want to make up for lost time by rushing into things.

But usually this isn't a good idea during the early stage.  You need to learn coping skills and develop internal and external resources before you begin to deal with trauma.

Getting Help in Therapy

Once you have developed coping skills and the therapist assesses that you're ready, then you can begin to work on the underlying emotional trauma.

Being safe, both physically and emotionally, is the first priority.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individuals and couples.

I have worked with many clients who are in recovery.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.